14 Role of Pathology in the Diagnosis and Management of Neoplastic Diseases

Question 1

What is the most common benign breast neoplasm?

Answer 1

Fibroadenoma

Question 2

Who tends to get breast fibroadeomas?

Answer 2

women <30yrs

Question 3

What is the most common malignant breast neoplasm?

Answer 3

breast carcinoma

Question 4

Who tends to get breast carcinoma?

Answer 4

older women >50

Question 5

Where do most malignant neoplasms originate from?

Answer 5

epithelium

Question 6

Where do most benign neoplasms originate from?

Answer 6

mesenchyme

Question 7

In which layer of the colon do the majority of neoplasms arise?
Why?

Answer 7

90% arise from glandular epithelial cells int eh mucosa
these are adenocarcinoma

exposed to highest concentration of carcinogens
high turnover rate

Question 8

What is the most common site of colon carcinoma?

Answer 8

sigmoid colon

Question 9

What are the characteristics of sigmoid colon carcinoma?

Answer 9

stenosing
cause bowel obstruction
present with altered bowel habits

Question 10

What are the characteristics of ascending colon carcinoma?

Answer 10

polypoid
rarely cause bowel obstruction
insidious presentation (anaemia, weight loss)

Question 11

What are the 3 types of specimens received for pathological assessment?

Answer 11

Biopsy
Cytology
Surgical resection samples

Question 12

What are teh 3 types of biopsy?

Answer 12

endoscopic biopsy
Needle biopsy
Punch biopsy

Question 13

What are the 4 types of cytological specimen?

Answer 13

smears
endoscopic brushings
body fluids
fine needle aspiration specimens

Question 14

Why is diagnosing small cell carcinoma so worrying?

Answer 14

great majority have already metastasised by the time they present clinically

Question 15

What are the limitations of biopsy?

Answer 15

tumour heterogenity

targeting the lesion accurately

Question 16

What cytological techniques might you use to test bladder cancer?

Answer 16

cytology

cystoscopy

Question 17

Do well differentiated or undifferentiated neoplasms have better outcomes?

Answer 17

well-differentiated

Question 18

What are the 4 stages to Duke’s system for colorectal cancer?

Answer 18

A - confined to submucosa
B - through muscle serosa
C - lymph node involvement
D - distant metastases

Question 19

What is immunohistochemistry used for in tumour pathology?

Answer 19

establishing a diagnosis of malignancy

Question 20

Name a marker of cell turnover

Answer 20

Ki-67 labeling index
>20% - high metastatic potential
<2% low metastatic potential

Question 21

Breast carcinomas expressing HER2 growth factor can be treated with what?

Answer 21

Herceptin

Question 22

Breast carcinomas expressing oestrogen receptors may be treated with what?

Answer 22

hormone therapy

Question 23

GI stromal tumours expressing tyrosine kinase receptor c-KIT may be treated with what?

Answer 23

Gleevec

a tyrosine kinase inhibitor

Question 24

Name a molecular technique for tumour stuffs

Answer 24

in situ hybridisation

Question 25

What might in situ hybridisation be used for?

Answer 25

kappa and lambda light chains to demonstrate clonality in plasma cell infiltrates

to identify EBV-related neoplastic diseases

Question 26

What is PTLD?

Answer 26

Post-Transplant Lymphoproliferative Disease

range from polycloncal lymphoid hyperplasia (reversible) to monoclonal malignant lymphoma

majority related to EBV infection

Question 27

Name one more method used for molecular studies

Answer 27

RNA or DNA extracted from fresh or paraffin embedded samples of tumour tissue